The concept of cancer control recognises that, while it may not be possible to eradicate cancer, its impact and burden on the community can be reduced. Eight cancers have been targeted in this priority area - lung cancer, melanoma, non-melanocytic skin cancer, colorectal cancer, non-Hodgkin’s lymphoma, prostate cancer and cancer of the cervix and breast. In 1996, lung cancer accounted for 4% of years of healthy life lost through premature death or living with disability, with colorectal cancer and breast cancer accounting for 3% and 2% respectively (AIHW 2000a).

Incidence

The National Cancer Statistics Clearing House, within the Australian Institute of Health and Welfare, reported that 80,864 new cases of cancer were diagnosed in 1998. Of these, 43,595 were males and 37,269 were females - an age-standardised cancer incidence rate (age-standardised to the 1991 Australian Population Standard) of 475 for males and 346 for females per 100,000 persons. This equates to a lifetime risk of one in three males and one in four females who were directly affected by cancer (AIHW 2001a). This statistic excludes approximately 270,000 annual diagnoses of non-melanocytic skin cancers, which are the most common form of cancer in Australia, but for which data are not collected routinely by cancer registries.

Survival from cancer depends on a number of factors, including whether the cancer is fast or slow growing, its metastatic characteristics, its stage at diagnosis, the availability of appropriate treatment and other co-morbidities. The Australian Institute of Health and Welfare estimated that for the period 1992 to 1997, the five-year relative survival proportions for cancer were 57% for males and 63% for females (AIHW 2001b).

Mortality

In 1999, malignant neoplasms (cancer) accounted for 35,053 deaths,which was 27% of all deaths. There were 19,866 male deaths and 15,187 female deaths due to cancer. Overall, cancer of the trachea, bronchus and lung was the leading cause of cancer deaths, accounting for 19% of all such deaths. Among males, the leading causes of cancer death were cancer of the trachea, bronchus and lung (23% of all male cancer deaths), followed by prostate cancer (13%) and colon cancer (9%). Among females the leading causes of cancer death were breast cancer (16% of all female cancer deaths), followed by cancer of the trachea, bronchus and lung (14%) and colon cancer (10%). Age-specific death rates for cancer increased markedly with age and were generally greater for males than for females, apart from age groups between 25 and 54 when female deaths from breast cancer tend to occur.

Cancer screening

Screening is currently believed to be the most effective method of reducing mortality from breast and cervical cancer. The National Program for the Early Detection of Breast Cancer was established in 1991; since 1994 it has been called BreastScreen Australia. The main aim is to detect small cancers in the breast which are more easily treatable while in their early stages and to reduce mortality and morbidity. The program recommends that women in the target age group (50-69 years) have a mammogram every two years. Women in their forties and seventies also have access to mammography without charge through this program, but are not actively recruited (AIHW 1998).

Although Pap smears have been available since the 1960s, the National Cervical Screening Program did not come into effect until 1991. The program seeks to detect the precursors to cancer or abnormalities of cells in the cervix which may lead to invasive cervical cancer. It is estimated that 90% of cervical cancers are potentially preventable (AIHW 1998).